


The sun did not shine

by SophieRomanoff97



Series: Sophie's Clintasha extravaganza [27]
Category: Marvel, Marvel Cinematic Universe, The Avengers (Marvel Movies), The Avengers (Marvel) - All Media Types
Genre: (possibly i am no expert), Angst and Feels, Angst and Hurt/Comfort, Awesome Clint Barton, Awesome Natasha Romanov, Blood, Blood and Injury, Clint Barton Feels, Clint Barton Needs a Hug, Clint Barton-centric, Clintasha Week, Clintasha forever, Cold, F/M, Found Family, Heavy Angst, Hospitals, Hurt, Hurt Clint Barton, Hurt Natasha Romanov, Hurt/Comfort, Hypoglycemia, Hypothermia, Idiots in Love, Injury, Love, Major Character Injury, Maria Hill is a Good Bro, Medical Inaccuracies, Medical Jargon, Medical Procedures, Mission Gone Wrong, Natasha Romanov Feels, Natasha Romanov Is Not A Robot, Natasha Romanov Needs a Hug, Natasha Romanov-centric, Phil Coulson Is a Good Bro, Protective Clint Barton, SHIELD, SHIELD Family, Sick Character, Sickfic, Snow, True Love, WHUMP WHUMP WHUMP, Whump, lots of whump very little else whoops
Language: English
Status: In-Progress
Published: 2020-02-06
Updated: 2020-02-06
Packaged: 2021-02-28 04:22:36
Rating: Mature
Warnings: Graphic Depictions Of Violence
Chapters: 1
Words: 4,349
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/22587844
Author URL: https://archiveofourown.org/users/SophieRomanoff97/pseuds/SophieRomanoff97
Summary: 'When Clint found Natasha she was strewn across the snow on her left side. It would have looked like she was about to make a snow angel, had it not been for the blood.'Stuck in the middle of nowhere, hypothermic and confused, Clint and Natasha must do everything they can to stay alive as they wait for their ride out of there. Will Shield get there in time to save them?
Relationships: Clint Barton/Natasha Romanov
Series: Sophie's Clintasha extravaganza [27]
Series URL: https://archiveofourown.org/series/1591042
Comments: 2
Kudos: 43





	The sun did not shine

**Author's Note:**

> Title taken from Dr. Seuss.
> 
> This is a chapter taken from my All The Avenger's Whump fic here: https://archiveofourown.org/works/16818715/chapters/39478342  
> But I spent all day on it and it's way longer than the other chapters so I decided to post it as it's own fic too. I hope you enjoy it! There will be a recovery prologue for that sweet sweet clintasha goodness.
> 
> TW'S: hypothermia, hospital, hospital treatment, life-saving treatment and procedures, anxiety, blood, injury, sickness etc etc all the stuff you expect from me :)
> 
> Edit a week too late: the experience Clint describes of the man who was left in the cold came from Jeremy Renner's character in the film Wind River. (It has Elizabeth Olsen in too and is v good but v heavy just in case you want to watch it)

When Clint found Natasha she was strewn across the snow on her left side. It would have looked like she was about to make a snow angel, had it not been for the blood.

The archer forced his bare feet, frozen like ice blocks, to move towards her.

As he got closer, he noticed the crumpled bodyguard, clearly too broken to be alive. Looking up, Clint saw the smashed window and it wasn't hard to understand what had happened.

Natasha and the guard had fought, he'd pushed her towards the window and knowing she was going to fall, she had brought the man with her.

It looked like the woman had twisted mid fall, probably to protect her back, but also likely to make sure the man landed first.

Clint dropped to his knees besides Natasha, rolling her as gently as he could onto her back.

Her face was coated with blood and shards of glass and somehow, she'd hit her head.

Clint didn't know how long she'd been there, it had taken him almost an hour to get out of his bonds and kill his own guard before running to find his partner. She could have been out there for nearly the whole hour.

There was blood on her lips, and as he gently wiped at her face to try and find the source of the blood, he found himself suddenly filled with terror. What if the blood on her mouth wasn’t from the fall, or being hit? He’d seen something once, in the middle of fucking nowhere like they were now, that would never leave his head.

A man in his strike team had disappeared, when they finally found him, he was lying in the snow, coughing up blood so red and warm it melted the snow below his cheek. Clint had been calling for backup when the man stilled, blood still dripping from his lips.

The coroner said the man had been out in the cold for so long that his lungs had frozen and filled with blood. Even if they’d gotten there hours earlier, they couldn’t have saved him.

Surely that wouldn’t have happened to Natasha, it had only been at most an hour, that wasn’t enough time for it to happen. Right?

Fuck.

“Nat?” Clint cupped a flushed cheek, ice cold, feeling sick to his stomach. His thumb ran gently over her eye and her cheek before he got a little rougher and tapped at her face. “Nat, open your eyes,” he exhaled shakily, his breath frosting in the air.

The archer’s free hand moved to rest against the hollow of the woman’s throat. She wasn’t shivering which meant they’d already gone from mild hypothermia into more dangerous territory. But her pulse was fast against his fingers, meaning they weren’t into severe yet. 

She’d twisted to avoid her back hitting the ground so Clint felt at least semi sure that she hadn’t injured her spine. So making a decision, Clint forced himself back to his feet, slightly aware that he was shuddering so hard his teeth were clashing together. He was a little dizzy, which didn’t bode well, but getting inside was a priority.

He gently slid his arms under Natasha, grunting a little at the pain radiating through his hands from the cold. His feet were numb so he more stumbled than walked into the small two floored cabin Natasha had been thrown out of.

Once inside, Clint lowered Natasha to the couch and sank to the floor in front of her, trying to force his scrambled egg brain to tell him what to do next. 

They had to get warm and Natasha had to get out of her wet clothes and into dry ones. Which would, obviously, be a lot easier if she were awake. But then, what if her head injury was more dangerous to her health than the hypothermia?

Shit, shit, shit, they were in so much trouble.

Rolling onto his knees, Clint gently parted Natasha’s hair, ice crystals settled amongst the red strands, to see if he could find where she’d been hurt. It didn’t take too long to find the culprit, there was a fairly decently sized lump behind her left ear, leaking a trail of now dry blood down her cheek. He probed as gently as he could, trying to determine whether she’d fractured her skull or just bruised it.

Pretty sure it was bruised and not fractured, hopefully, Clint used one hand to close the fingers on his other. He rubbed his knuckles up and down Natasha’s sternum, stroking across her cheek with his other hand.

It wasn’t as if she was out one minute and then conscious the next, it took a couple minutes of coaxing and prodding for Natasha’s eyes to fully open. 

The woman swallowed reflexively, eyes struggling to focus.

“Hey babe.” Clint murmured, cupping her jaw. “Just take it easy, nice and slow, you’re okay.” He actually wasn’t sure if that was true. They were in the middle of nowhere with no transport, no phone, no extraction planned for another day at least.

“F…fuck-“ Natasha muttered, blinking tiredly. “’S fucking cold.” Her voice was a little slurred and that in itself send stabs of terror down Clint’s spine.

“I know, love. We need to get you in to dry clothes, okay?” The archer looked quickly at his surroundings. He hadn’t been in that cabin, he’d been in one of the others but the layout was pretty much the same. It had been their mark’s cabin, before Natasha had killed him, so Clint wasn’t worried about anybody unexpectedly dropping by.

“Okay, I’m going to run and grab you some clothes.” Clint offered a weak approximation of a reassuring smile. “Try not to move, love.”

Knowing there wasn’t any time to wait, Clint pushed himself up. The sudden change in temperature meant his feet were agony with every step, what felt like fire crawling up his ankles. He grit his teeth, letting out a string of grumbled curses as he half ran, half hopped, up the stairs.

The shattered window made things more difficult, the whole cabin would be far colder because of the freezing wind rushing in through it. But the other cabin was too far away to safely get Natasha there. Moving someone with hypothermia was advised against, unless it was to get them inside after being outside, and Natasha was already slipping into the moderate range of hypothermia, so moving could trigger worse things, things that Clint stubbornly tried to ignore.

He rummaged quickly through the wardrobes in their mark’s bedroom, pulling out the biggest and thickest items of clothing he could. He took some for himself too. He was still shaking, so his own hypothermia was mild at worst so with warm clothes, he was likely to be okay. But he couldn’t help his partner if he himself got worse.

Since it hadn’t been actually snowing when Clint had found Natasha, only his pants were wet so as quickly as he could, he stripped his lower half and clambered into a few pairs of pants and multiple layers of socks before slipping on a sweatshirt and carrying the rest of the clothes downstairs.

As Clint passed the fireplace, his hopes were quickly squashed. It was a wood burning fire. Except there was no fucking wood in the holder next to it. So fat lot of good that was. Maybe he could find some books to burn, but the flames wouldn’t last as long as they needed them to.

When Clint got down on his knees besides the couch again, Natasha was thankfully still awake, but there was a glassiness to her gaze that didn’t bode particularly well. “We’re going to be really gentle with this, you let me do all the work.” He told his partner. “We’re gonna get you out of these and into something dry and you’ll feel better in no time.”

Natasha blinked at him, swallowing and nodding weakly. “’Kay.” She breathed, fumbling fingers reaching to Clint’s cheek, her icy fingertips ghosting over his skin. 

“You’re gonna be okay, Nat.” He said firmly as he slowly and carefully moved Natasha up so he could pull down the zip of her catsuit and get it off her shoulders. Once at her waist, Clint pulled an undershirt, a t-shirt, and a sweatshirt over her head before laying her back down. Her lower half was easier and soon she was in sweatpants and multiple pairs of socks. 

Clint supposed it was good they were in the cabin, since there had been a lot of items for going out into the snow, including hats and gloves. With a hat pulled over Natasha’s head and gloves on her hands, the archer was on to blankets.

Clint wrapped Natasha up with the soft material like she was the most important gift in the world. And to him, she was.

“How are you feeling?” He murmured, leaning forward to press a kiss to her temple. 

“Okay.” She croaked, wincing a little. She still wasn’t shivering, which meant her temperature was still far too low, but she was able to speak and follow him with her eyes, so he was counting that as a good thing.

“You have to be honest with me, love, okay? So I know how to help.” Clint squeezed her hand very very gently.

“I’m tired.” The redhead breathed, exhaling shakily. 

She couldn’t go to sleep. She couldn’t. Fuck fuck fuck.

“I know.” Clint smiled weakly. “But you’ll be okay. I’m going to start the fire and then get in with you, yeah?” They didn’t have a heated blanket or hot water bottles or anything of the sort because Clint guessed their mark was a fucking idiot who apparently didn’t like to be fucking warm. So body heat and the fireplace were their only real options. Luckily, the couch was close enough to the fire that he wouldn’t have to move Natasha to the floor or anything.

Finding things that were non toxic to burn proved a little difficult. Clint ended up throwing a large pile of books and a chair he hacked up with a kitchen knife, into the fireplace. Five minutes later, and the fire was going. The flames snapped and crackled in a way they probably shouldn’t have but at least it was warm. 

Despite the fact that they were now inside and clothed properly and next to the fire, Clint didn’t feel great. His feet stung and his thoughts were a little tangled. He knew it wasn’t good, he just hadn’t realized quite how bad it was. He hadn’t noticed that he’d stopped shivering himself, or that his heart pounded faster as he continued to move around the cabin.

He was breathless and dizzy by the time to fire was properly going, rubbing at his eyes as he tried to recall what he’d just been about to do. Frowning, he glanced around the room before settling on Natasha. Oh, right, body heat.

Natasha didn’t say anything as Clint pulled up the blankets and slipped himself in behind her, one arm winding over her waist. The redhead didn’t seem very aware of what was happening and had Clint been more coherent himself, he would have known she was worse. But thinking was getting harder and harder and he was tired.

Every survival instinct should have been screaming at him to stay awake, but his thoughts were mushy and Clint closed his eyes.

…

When he woke up, it was dark, and Natasha was gone.

Wakefullness wasn’t exactly wakeful. He felt bone tired and shaky, blinking felt too difficult and moving even more so.

It took him a while to understand, to even remember where he was and what had happened. It was then he realized his partner was gone.

Forcing exponentially weak legs to move, Clint pushed himself up from the couch. He almost fell, dizziness overwhelming, but as the ringing in his ears begin to die down, he realized he could hear faint breathing coming from somewhere close.

It didn’t take long for Clint to find Natasha, he just followed the trail of clothes until he got to the dining room table. Natasha was curled underneath one of the chairs, half clothed and unconscious. Her breathing was ragged but slow, too slow, and as Clint clumsily reached for a pulse, it took at least ten or fifteen seconds for him to feel a slow pulse under his fingers. It was more of a flutter than a beat, so he knew her temperature had dropped below 28 degrees. It sounded like she was having trouble breathing.

Grabbing the blankets from the couch, Clint crawled under the table, swathing the woman with the material. “Nat?” He whispered, fingers tenderly cupping her jaw as tears welled in his eyes. “Tash, please.” 

He knew she wouldn’t respond, couldn’t respond. 

She was going to stop breathing soon and he was in the middle of nowhere with no access to medical equipment or a hospital. Not only was she close to arresting but the longer Clint stayed upright, the more ill he began to feel. He could feel his own pulse in his temples and thinking, once again, got harder and harder. 

Warm.

Had to get warm.

Clint got under the blankets, wrapping his arms around Natasha, burrowing against her neck. Too tired. Too much. 

He had to help Natasha, had to…what was it he had to do?

Through no choice of his own, Clint’s eyes slipped shut once more.

…

He awoke again in confusion. 

This time there were voices around him and something heavy settled on his body.

It took what felt like ten years to open his eyes, finding himself staring up at the ceiling of a hellicarrier. Which meant…

“Easy, Clint.” A voice murmured, a steadying hand on his shoulder to stop him from getting up.

Brows furrowed, confusion in his expression, Clint looked up at his superior officer. He tried to speak but found no words were willing to come out. 

“Stay still, you don’t want to pull anything out.” Phil murmured, slowly taking his hand from the man’s shoulder. “You’re going to be okay, we’re just getting you to the hospital, okay?”

Natasha was usually beside him, if he’d been hurt then where…

Eyes widening, Clint ignored all of Phil’s warnings and pushed himself up into a sitting position. He didn’t have to search for long to find his partner.

Natasha was buried under a pile of blankets, a tube sticking out of her mouth. Clint knew what that meant; she wasn’t breathing on her own. 

They were in the air, they had medical equipment, but not many hellicarrier’s were going to carry the equipment needed for severe hypothermia, so they couldn’t start a heart lung machine or haemodialysis, the most effective ways to treat severe hypothermia.

Clint hadn’t had time to consider what treatment he himself was receiving, it wasn’t until he took a second that he realized he had a mask over his mouth and at least two needles embedded in his hands. Flicking his gaze up to Phil, Clint watched as his superior office slowly took a seat. 

“You’re getting heated oxygen.” Phil pointed at the mask. “That’s warm fluid,” he pointed at Clint’s left arm, “that one’s glucose. You were hypoglycaemic when we found you. Heated blanket.” He lastly pointed towards Clint’s torso.

Clint wasn’t particularly bothered about himself. He looked over at Natasha, unable to hide his anxiety. He knew the breathing tube wasn’t good, but how bad was it?

Phil swallowed, jaw clenching a little. He swallowed and rubbed a hand over his face. “They did CPR for a while.” He said quietly, “her heart was beating about twice every minute, it’s come up since then but…”

Clint understood. They didn’t have the right equipment. 

“She’ll need a bypass when we touch down.” Phil murmured as Clint’s eyes strayed to his partner again. She had leads sticking out from the blankets and despite the fear running through him, he forced himself to look at the screen. Phil had said her heart rate had come up, but he hadn’t said it had been only by a few beats.

She was so pale.

Clint watched her for a while. She was still and small under the blankets. He hadn’t looked after herproperly. He hadn’t helped her enough. He’d failed-

The screen began to sound an alarm and with horror, Clint realized Natasha’s heart hadn’t beat for a minute. 

Extreme hypothermia suppressed heart and brain function, it didn’t mean she would die, it didn’t…

“Please,” Clint croaked out, barely noticing as Phil took his hand, as his breathing mask fogged with the force of his breaths, of his panic. 

Logically, Clint knew CPR with a severely hypothermic person could last for a long time. It wasn’t the usual amount of minutes it was recommended to work on a non-beating heart. Her metabolism was lower, hypoxia wouldn’t set in until…

It didn’t matter how much Clint tried to fill his head with facts or knowledge, Natasha wasn’t breathing, her heart wasn’t beating, and he had never been so terrified. 

He was shaking desperately, gasping, hand clutching Phil’s so hard he was close to breaking bones.

“Easy, easy Clint, just breathe, they’re helping her, she’s okay.” Phil murmured. “Just breathe, Barton.”

Until her temperature came up to 30 degrees, if at that point her heart still didn’t beat, that would mean…it would mean she was dead.

Clint couldn’t breathe.

He watched as medics rythmatically pushed down on her chest, now exposed to the cold, as they pressed the bag that breathed for her, as more needles got pushed into her pale skin.

He couldn’t breathe.

Ears roaring, Clint knew someone was trying to speak to him, there were hands on him but all he saw was Natasha. His partner, his best friend, all but dead right next to him, because of him. Because he hadn’t taken good enough care of her. He hadn’t stayed awake, hadn’t kept her warm, hadn’t-

Something cold slid into the hollow beneath his jaw and everything got hazier and hazier until he could only see the fiery red of Natasha’s hair, and then nothing.

…

Clint was sick of passing out and waking back up.

The first thing he noticed was that he wasn’t shaking anymore. The second was that, despite just waking up, his head felt clearer than it had in as long as he could remember. The third was that he wasn’t alone. 

He hadn’t been expecting to see Maria, but he was glad she was there. His voice was hoarse when he cleared it, expression full of fear. If he’d been out for too long, if Natasha had…

“She’s alive.” Maria said immediately upon noticing Clint was awake. She moved quickly to the bed, hand on his shoulder. “Breathe for a sec, Barton, or you’ll get dizzy. Nat’s alive, okay? They started the bypass, dialysis, got her hooked up to a better breathing machine. She’s still getting the warm fluids and her temp is coming up, it’s looking good. You’ve been out for a while so be slow, I am not explaining to Phil that I let you pass out again.” She said firmly, raising an eyebrow as she lifted her hand from his shoulder, just like Phil had done earlier. Apparently they didn’t trust him not to get up right away…yeah, they were right to not trust that.

Clint winced as he slowly lifted himself up onto his elbows, rubbing absently at his chest. It hurt, probably from the oxygen. “Where is she?” He asked quietly, voice rough and low.

“ICU.” Maria murmured, looking away for a fraction of a second. 

She looked…Clint couldn’t think of what her expression was, but it wasn’t good. 

“You watched, didn’t you? When they brought us in.” Clint said, voice shaky.

“Yeah.” The woman nodded, tucking hair behind her ear and sighing. “It didn’t…she looked…”

“Dead.” Clint supplied, feeling bile rise in his throat. 

Maria looked back at him, catching his gaze. “Yeah.” She whispered, “she did.” Clearing her throat, she gestured at him. “You didn’t exactly look great. Coulson had to tranq you, said you were pulling your IV’s out.”

Frowning, Clint glanced down at his arms, just one needle in where there had been two. How long had he been out? 

“Wasn’t doing it on purpose.” He murmured, scratching absently at the back of his hand.

“I know.” The agent offered a small smile, understanding clear on her face. He’d just been scared, terrified really, and had wanted to reach her, to try and help, to do…anything, really.

“I know what you’re going to ask.” Maria said after a moment. “And there’s a few rules you’ll need to follow first.”

Clint groaned softly, sighing, frustrated. “Fine. What do I have to do before I can see her?”

“The doctor’s going to need to check you out. If he says you’re okay to move, you’ll be in a wheelchair and you’ll need to shower and use scrubs.” Maria’s face morphed into another expression quickly enough that Clint got worried.

“What? What is it?” He frowned.

“There is one more thing.” Maria started, gesturing weakly at his foot. “Your hypothermia wasn’t as severe as Nat’s but your…well…how long were you out there with no shoes or socks?”

Clint blinked, and blinked again before reaching to pull the covers from his feet. One foot had the socks he’d taken from the cabin on and the other had bandages. “Ah, fuck.” He muttered, poking at his toes experimentally. “How bad?”

Maria pulled a face, looking empathetic. “One and a half.”

“Fuck, really? Dammit, I thought I’d warmed up quickly enough.” Clint rubbed at his forehead. He only had three and a half toes on his left foot now. Awesome, that was just great.

Quirking an eyebrow, Maria leaned forward. “Clint, you literally were not warm. At all. That’s why they had to use the IV’s and mask?”

“But I…I was shaking? That meant it wasn’t bad?” The archer rubbed at his forehead. The memories from the cabin were…somewhat hazy. As he realized that some moments were just gone from his head, he began to understand what Maria was saying. 

“I didn’t feel that bad.” He said quietly, “I tried to keep us warm but I guess…how did I mess up so bad?”

“Clint, seriously? You didn’t mess up. At all. You were hypothermic and beyond confused, with how low your glucose was, you shouldn’t have been able to do much at all. But somehow, you got yourself and Natasha dry, used multiple layers, found blankets, lit a fire with books and used your knowledge of it all to realize that body heat was going to help. You do realize that if you hadn’t done that, Nat wouldn’t be here, right? And there’s a good chance you wouldn’t be either. That cabin was freezing and we have no idea how long you’d both been sick because when we got there for pick up, you were both under the table.” Maria leaned forward, squeezing Clint’s hand. “You did so good, Barton. You saved Natasha and yourself, even though you were confused as fuck. Okay?”

Clint wasn’t sure how he could ever argue with that amount of knowledge thrown at him. So in the end, all there was left to say was, “okay.” And then it was time to get ready.

…

Apparently Clint had been out for almost a whole day. His temperature was back up, if still a little bit low and his glucose and fluid levels were still not good enough to come off the IV, but after Clint insisted very strongly, and maybe threatened a tiny bit, it was decided he could see Natasha. He would just have to be pushed, and have to drag along an IV stand, but it was worth it.

He showered with great difficulty, needing a nurse to help so he didn’t fall over and crack his skull open or something. Clint didn’t care. Because soon enough he was in a wheelchair and being taken to his partner.

The archer would have been lying if he’d said seeing the massive machine keeping Natasha alive wasn’t terrifying. Acting as her heart, as her lungs. It was huge and like something out of a sci-fi movie. 

They’d gone in through the side of her neck instead of her chest, it was less invasive that way, he supposed, and there wasn’t anything technically wrong with her heart, it was slow from the cold. So whilst her temperature slowly got up, the need for the machine would, hopefully, diminish and her organs would function on their own.

There were tubes everywhere, hissing and strange noises coming from the machine and tubing alike. Clint immediately hated and loved the noises. They wouldn’t be using it if she wasn’t alive, but they also wouldn’t be using it if she was okay. 

The nurse wheeled Clint as close as he could get to the bed without being in the way. He took one of Natasha’s hands and sank back in the chair, watching and waiting. She had a few stitches dotted in her hair but apart from that, if he focused very hard on her face from the nose up, she looked like she could be sleeping. 

At least her skin looked more normal, not pale and ghostly and not flushed and red either. Pink. Normal. 

Her hand was cold in his but nothing like the icy touch that had skirted over his skin back at the cabin.

She would be okay. Sure, it was probably the scariest way either of them had ever had their life saved, but Natasha’s life was saved. That was what mattered.

She was alive and there with him, at his side. 

Clint would be grateful for that forever, and after.

…

When Natasha came off the machines two days later, eyes opening hours after, Clint felt like he was finally home.

**Author's Note:**

> Information on what occurred, especially with Natasha, if you guys want a little more (taken from Wikipedia):
> 
> Treatment overwiew:
> 
> The treatment of mild hypothermia involves warm drinks, warm clothing, and physical activity. In those with moderate hypothermia, heating blankets and warmed intravenous fluids are recommended. People with moderate or severe hypothermia should be moved gently. In severe hypothermia, extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful. In those without a pulse, cardiopulmonary resuscitation (CPR) is indicated along with the above measures. Rewarming is typically continued until a person's temperature is greater than 32 °C (90 °F). If there is no improvement at this point or the blood potassium level is greater than 12 mmol/liter at any time, resuscitation may be discontinued.
> 
> Paradoxical undressing:
> 
> Twenty to fifty percent of hypothermia deaths are associated with paradoxical undressing. This typically occurs during moderate and severe hypothermia, as the person becomes disoriented, confused, and combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss.
> 
> One explanation for the effect is a cold-induced malfunction of the hypothalamus, the part of the brain that regulates body temperature. Another explanation is that the muscles contracting peripheral blood vessels become exhausted (known as a loss of vasomotor tone) and relax, leading to a sudden surge of blood (and heat) to the extremities, causing the person to feel overheated.
> 
> Terminal burrowing:
> 
> An apparent self-protective behaviour, known as "terminal burrowing", or "hide-and-die syndrome", occurs in the final stages of hypothermia. The afflicted will enter small, enclosed spaces, such as underneath beds or behind wardrobes. It is often associated with paradoxical undressing. Researchers in Germany claim this is "obviously an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behavior of protection, as seen in hibernating animals". 
> 
> Rewarming:
> 
> Rewarming can be done with a number of methods including passive external rewarming, active external rewarming, and active internal rewarming. Passive external rewarming involves the use of a person's own ability to generate heat by providing properly insulated dry clothing and moving to a warm environment. Passive external rewarming is recommended for those with mild hypothermia.
> 
> Active external rewarming involves applying warming devices externally, such as a heating blanket. These may function by warmed forced air (Bair Hugger is a commonly used device), chemical reactions, or electricity. In wilderness environments, hypothermia may be helped by placing hot water bottles in both armpits and in the groin. Active external rewarming is recommended for moderate hypothermia. Active core rewarming involves the use of intravenous warmed fluids, irrigation of body cavities with warmed fluids (the chest or abdomen), use of warm humidified inhaled air, or use of extracorporeal rewarming such as via a heart lung machine or extracorporeal membrane oxygenation (ECMO). Extracorporeal rewarming is the fastest method for those with severe hypothermia.
> 
> Cardiac arrest:
> 
> In those without signs of life, cardiopulmonary resuscitation (CPR) should be continued during active rewarming. In Europe, epinephrine is not recommended until the person's core temperature reaches 30 °C (86 °F), while the American Heart Association recommends up to three doses of epinephrine before a core temperature of 30 °C (86 °F) is reached. Once a temperature of 30 °C (86 °F) has been reached, normal ACLS protocols should be followed. It is usually recommended not to declare a person dead until their body is warmed to a near normal body temperature of greater than 32 °C (90 °F), since extreme hypothermia can suppress heart and brain function
> 
> Heart lung machines/cardiopulmonary bypass:
> 
> Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation. ECMO works by removing blood from the person's body and artificially removing the carbon dioxide and oxygenating red blood cells. Generally, it is used either post-cardiopulmonary bypass or in late-stage treatment of a person with profound heart and/or lung failure, although it is now seeing use as a treatment for cardiac arrest in certain centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation are supported.


End file.
